Relationship quality,COVID stress,and mental health in sexual and gender minority young adults

Abstract

Sexual and gender minority (SGM) individuals, particularly those assigned female at birth (AFAB), have shown poor mental health outcomes during the COVID-19 pandemic. This issue highlights the importance of identifying factors that may promote SGM-AFAB mental health during the pandemic and protect SGM-AFAB individuals against the negative psychological effects of COVID-related stress. Grounded in previous research and theory suggesting that high quality romantic relationships have promotive (i.e., main) and protective (i.e., stress-buffering) effects on partner’s mental health, we explored associations between relationship quality, COVID-related stress, and mental health among SGM-AFAB individuals. Specifically, we tested whether (1) higher relationship quality, as a promotive factor, was directly associated with fewer mental health problems (depressive and anxiety symptoms, problematic alcohol and cannabis use), and (2) relationship quality, as a protective factor, had a stress-buffering effect, reducing the negative effect of COVID stress on mental health within SGM-AFAB young people. Between May 2020-July 2021, 227 SGM-AFAB individuals (ages 19–35; M = 23.5) in current romantic relationships completed measures of pandemic-related stress, relationship quality, depressive and anxious symptoms, and problematic alcohol and cannabis use. As hypothesized, relationship quality was negatively associated with anxious and depressive symptoms and problematic cannabis use. Relationship quality attenuated the positive association between COVID stress and depression, but not the other mental health outcomes. Findings suggest that high-quality romantic relationships may promote mental health and have a stress-buffering effect for depressive symptoms among SGM-AFAB individuals during major society-wide stressors.

Keywords

Relationship quality mental health LGBTQIA+stress COVID-19 depression young adults

Introduction

The COVID-19 pandemic has had a negative impact on the global population. In addition to regular daily stressors, many have experienced COVID-related stress (Taylor, 2021), including fears of infection and physical health consequences; fears of the economic consequences of a pandemic, such as employment loss; and stress around social isolation and loneliness. Globally, COVID stress has been associated with mental health problems and substance use (Xiong et al., 2020) and international research has documented worsening mental health (e.g., increased anxious and depressive symptoms; Haliwa et al., 2021; Hoffart et al., 2021) and substance use (e.g., increased rates of problematic substance use; Bartel et al., 2020; Pollard et al., 2020) during the pandemic. While the effects of COVID-19 have been widespread, evidence suggests that the well-being of sexual and gender minority (SGM) individuals has been impacted more negatively than that of cisgender heterosexual people (Buspavanich et al., 2021; McGowan et al., 2021), likely due to structural inequities and stigma. SGM have reported significant financial ramifications due to COVID-19 (Jarrett et al., 2021; MacCarthy et al., 2020), and their higher rates of pre-existing conditions (e.g., asthma, diabetes) and lower rates of healthcare coverage (Whittington et al., 2020) have made them more susceptible to serious illness if they contract COVID-19 compared to cisgender, heterosexual people. In addition, during shelter-in-place orders, many SGM have been isolated from their affirmative support networks (e.g., friendship networks, SGM community centers, or college support groups; Hafi & Uvais, 2020; Suen et al., 2020), and some have been forced to quarantine with unsupportive roommates or families (Gato et al., 2021).

Not surprisingly, SGM perceive these COVID-related experiences as negatively impacting their psychological well-being (Philpot et al., 2021) and quantitative studies indicate that COVID stress is associated with mental health problems and substance use among SGM (e.g., Akré et al., 2021; Kamal et al., 2021). Accordingly, SGM individuals have experienced a decline in their mental health, including increased symptoms of anxiety, depression and psychological distress (Flentje et al., 2020; Kidd et al., 2021) and increased alcohol and cannabis use (Czeisler et al., 2020; Slemon et al., 2022) since the start of the pandemic. Evidence suggests that the COVID-19 pandemic has widened existing mental health and substance use disparities faced by SGM people (e.g., Kamal et al., 2021; Peterson et al., 2021). Consistent with pre-pandemic trends, assigned female at birth (AFAB) individuals reported higher rates of depression and anxiety when compared to assigned male at birth (AMAB) individuals during the pandemic (Xiong et al., 2020), putting SGM-AFAB at particularly high risk for poor mental health outcomes and problematic substance use.

Given the significant stressors, worsening mental health, and increased substance use experienced by many SGM individuals during the pandemic, particularly SGM-AFAB, it is essential to identify factors that promote (i.e., have direct positive effects on) SGM-AFAB individuals’ well-being and protect their well-being, buffering them from the negative effects of COVID-related stress. In other words, it is important to determine what factors have main effects and/or stress-buffering effects on SGM mental health during this major society-wide stressor. One potential such factor is high quality romantic relationships, which have well-established promotive and protective effects on mental health and substance use in the general population (Whisman & Baucom, 2012). High relationship quality has consistently shown concurrent and prospective associations with positive mental health (Braithwaite & Holt-Lunstad, 2017; Leach et al., 2013) and fewer substance use problems (Fleming et al., 2010; Leonard & Homish, 2008)—all examples of promotive effects. Further, support provided by a romantic partner, as seen in high-quality relationships, can weaken the association between stress and mental health problems (Cohen & Wills, 1985; Jackson, 1992), indicating protective effects of relationship quality on mental health in the face of stress.

Though research on SGM relationships is relatively new and limited, the studies that do exist suggest high quality romantic relationships have similar mental health and substance use benefits among SGM. High relationship quality among SGM has been associated with lower depressive symptoms cross-sectionally (Whitton & Kuryluk, 2014) and prospectively over one year (Gilmour et al., 2019). Further, in a multiwave study of partnered SGM-AFAB, relationship quality demonstrated negative within-persons associations with mental health problems; that is, SGM-AFAB had fewer depressive and anxious symptoms and less problematic substance use at times when their relationship quality was higher than at times when it was lower (Sarno et al., 2021). In addition to these promotive effects, there is evidence that relationship quality may have protective, stress-buffering effects for SGM; romantic involvement and high partner support have weakened associations between stress and individual well-being among SGM couples (Graham & Barnow, 2013; Whitton et al., 2018).

Together, these findings suggest that, during the stressful event of the COVID-19 pandemic, high relationship quality may both promote and protect the mental health of SGM individuals. That is, as a promotive factor, higher relationship quality may be directly associated with fewer mental health and substance use problems, and as a protective factor, relationship quality may have a stress-buffering effect, reducing the negative effect of COVID stress on mental health and substance use problems within SGM individuals. However, we were unable to locate any studies testing this possibility; existing research focuses predominantly on the negative impact of COVID stress on SGM relationship quality (Randall et al., 2022; Sachser et al., 2021), intimate partner violence (Parrott et al., 2021), and substance use (Gresham et al., 2021). Limited findings from the general population suggest involvement in high-quality relationships has been associated with lower levels of stress, anxiety, and depressive symptoms during the COVID-19 pandemic (Chua et al., 2021; Pieh et al., 2020), suggesting promotive effects. However, we were unable to identify any research testing relationship quality as a protective factor against mental health and substance use problems in the face of COVID-related stress in either general population or SGM samples.

To address these gaps in the literature, we explored how romantic relationships may have affected SGM mental health during the COVID-19 pandemic. Specifically, using a sample of SGM-AFAB young adults in romantic relationships, we aimed to (1) test whether relationship quality was negatively associated with mental health and substance use problems among SGM individuals during the pandemic, and (2) assess whether high relationship quality protected SGM individuals from the negative effects of COVID stress on mental health. We focused on SGM-AFAB, given that they are both underrepresented in the SGM literature (Coulter et al., 2014) and experience particularly high rates of mental health problems (Newcomb et al., 2020) and substance use (Watson et al., 2020). We focused on emerging adults, who are understudied in this literature, despite this being the developmental era when SGM mental health symptoms and disparities peak (Medley et al., 2016; Semlyen et al., 2016). Because emerging adult relationships tend to be transient and exploratory (Arnett, 2000), it is not clear if they will have the promotive or protective effects on mental health and substance use seen later in adulthood. We posited the following hypotheses for our aims:

(1) Higher relationship quality will be associated with fewer depressive and anxious symptoms and less problematic use of alcohol and cannabis (promotive effects).

(2) Relationship quality will show stress-buffering effects, attenuating the associations between COVID stress with the four indices of mental health (depressive and anxious symptoms, problematic use of alcohol and cannabis). That is, relationship quality will moderate the positive association between COVID stress and each mental health outcome, such that the association will be weaker for participants with higher, versus lower, relationship quality.

Methods

Participants and procedures

Data were drawn from FAB 400 (Whitton et al., 2019), an ongoing longitudinal cohort study of 488 racially diverse sexual and gender minorities assigned female at birth (SGM-AFAB), largely focused on development, mental health, and romantic relationships. FAB 400 utilizes a merged cohort longitudinal design; participants included SGM-AFAB from a prior cohort study of SGM, recruited in 2007, and a second cohort of SGM-AFAB, recruited in 2016-2017. At enrollment, inclusion criteria required participants to be assigned female at birth, aged 16–20, and report same-sex attraction or identify with a sexual or gender minority label. Participants were recruited directly from various venues, social media advertisements, and via snowball sampling. Both cohorts completed the FAB 400 baseline assessment in 2016-2017 and subsequent assessments at 6-month intervals. The study protocol was approved by the Institutional Review Board (IRB) at Northwestern University with a waiver of parental permission for participants under 18 years of age under 45 CFR 46, 408(c). Participants provided written informed consent and we obtained a federal certificate of confidentiality to uphold participant confidentiality.

For the present analyses, we utilized data from the Wave 7 assessment, which was collected remotely during the COVID-19 pandemic (from May 2020 to July 2021) via an online survey and included measures about participants’ pandemic-related experiences. We selected the 227 participants who reported current relationship involvement at this assessment. The demographic characteristics of the sample are presented in Table 1.

Table 1.

Sample characteristics.

Variable	N	%
Race/Ethnicity^a
Black	68	30.0
Latine	65	28.6
White	57	25.1
Other	33	14.5
Sexual identity
Gay/Lesbian	59	26.0
Bisexual/Pansexual	98	43.2
Queer/Other	70	30.8
Gender identity^a
Cisgender female	134	59.0
Gender minority	89	39.2
Personal income^b
< $20,000	148	65.2
$20,000-$39,999	52	22.9
$40,000-$59,999	11	4.8
$60,000-$79,999	7	3.1
> $80,000	2	0.9
Cohabiting^c	94	41.4
Children living in the home	25	11.0

Note. N = 227.

^aFour (1.76%) participants did not answer this question.

^bSeven (3.08%) participants did not respond to this question.

^cFive (2.20%) participants did not answer this question.

Measures

Demographic information

Participants self-reported demographic characteristics including age, race/ethnicity, gender identity, and sexuality. For analyses, race/ethnicity was recoded into four categories: Black, Latine, White, or Other. Gender identity was recoded into cisgender women and gender minority individuals (i.e., transgender, gender nonconforming, gender nonbinary). Sexual identity was coded into three categories: gay/lesbian, bisexual/pansexual, and queer/other (i.e., queer, questioning, asexual, and other identity).

COVID stress

An investigator-created scale measured level of stress related to the COVID-19 pandemic across various life domains. Participants responded to six items: “How much has your [daily life been affected/interactions with other people been reduced/emotional and psychological well-being been negatively affected] by the COVID-19 pandemic?”; and “How much do you worry about how the COVID-19 pandemic will impact your community/you financially [i.e., loss of wages]/your health and well-being?” on a 5-point scale (1 = not at all to 5 = extremely). A principal component analysis indicated a single factor (all items had factor loadings >.70), which explained 61% of the variance. Internal consistency was excellent (α = .87). Scores were calculated by averaging the 6 items and reflect the average rating across items (i.e., higher scores indicate more negative COVID-19 impacts on participants’ lives; Whitton et al., 2023).

Relationship quality

On the Relationship Assessment Scale (RAS; (Vaughn & Matyastik Baier, 1999), participants rated 7 items (e.g., “How well does your partner meet your needs?”; “How much do you love your partner?”) on a 5-point scale (1 = not at all to 5 = very much). Higher scores indicate greater relationship quality. Scores were calculated by averaging the 7 items (α = .87).

Mental health outcomes

Depressive symptoms

On the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression – Short Form 8b (Pilkonis et al., 2011), participants indicated frequency of 8 symptoms (e.g., “I felt unhappy; ” “I felt that I had nothing to look forward to”) in the last 7 days on a 4-point scale (1 = never to 5 = always). Higher scores indicate greater depressive symptoms. Scores were calculated by summing the 8 items (α = .99).

Anxious symptoms

On the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety – Short Form 8a (Pilkonis et al., 2011), participants indicated frequency of 8 symptoms (e.g., “I felt nervous; ” “I found it hard to focus on anything other than my anxiety”) in the last 7 days on a 4-point scale (1 = never to 5 = always). Higher scores indicate greater anxious symptoms. Scores were calculated by summing the 8 items (α = .95).

Substance use

Alcohol use

On the Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 2001), participants rated 10 items (e.g., “How often have you failed to do what was normally expected of you because of drinking?” and “How often do you have a drink containing alcohol?”) on a 4-point scale to assess their experience during the last 6-month. Higher scores indicate more problematic alcohol use. Scores were calculated by summing the items (α = .81). Scores were logarithmically transformed to address positive skew (Bartlett, 1947).

Cannabis use

On the Cannabis Use Disorders Identification Test-Revised (CUDIT; Adamson et al., 2010), participants rated 8 items (e.g., “How often do you use cannabis?” and “How often have you had a problem with your memory or concentration after using cannabis?”) on a 4-point scale to assess their experience during the last 6-month. Higher scores indicate more problematic cannabis use. Scores were calculated by summing the items (α = .77). Scores were logarithmically transformed due to substantial positive skew (Bartlett, 1947).

Results

Preliminary results

Preliminary results (see Table 2) demonstrated that, on average, levels of depression and anxiety were mild (according to cutoffs set by the American Psychiatric Association; n.d.). Alcohol use and cannabis use were both low on average, indicating low risk of these substance use disorders in the majority of the sample. Relationship quality was high, with the average score indicating that participants felt satisfied to very satisfied with their relationships. Levels of COVID stress fell, on average, between some stress and moderate stress.

Using one-way ANOVAs and Bonferroni post-hoc tests for race/ethnicity and sexuality, demographic differences were examined in COVID stress, relationship quality, and mental health variables. Black participants reported lower scores on depression and alcohol use compared with White participants, as well as lower scores on anxiety and COVID stress compared with both Latine and White participants. Relationship quality was significantly lower for Black participants compared with those of an Other race/ethnicity but did not differ from those with White or Latine identities. Gender minority individuals reported higher levels of COVID stress, anxiety and depression compared with cisgender women. Regarding sexual identity, depression scores were marginally higher for queer/other participants than bisexual/pansexual participants (p = .07) and gay/lesbian participants (p = .08). Anxiety was significantly higher for queer/other participants than both gay/lesbian and bisexual/pansexual participants. COVID stress was significantly lower for gay/lesbian participants compared with both bisexual/pansexual participants and those of a queer/other identity. Pandemic duration was negatively associated with alcohol use, r(223) = −.24, p < .01. Relationship duration was negatively associated with COVID stress, r(224) = −.21, p < .01, and alcohol use, r(223) = −15, p < .05. Relationship quality, COVID stress, and mental health outcomes did not differ by cohabitation status.

Table 2.

Descriptive statistics and bivariate correlations among study variables.

	M (SD)	1.	2.	3.	4.	5.	6.	7.	8.	9.
1. Depression	17.8 (8.2)	—
2. Anxiety	20.6 (8.7)	.77**	—
3. Alcohol use	.55 (.4)	.25**	.24**	—
4. Cannabis use	.58 (.5)	.25**	.28**	.36**	—
5. Relationship quality	4.3 (.7)	−.21**	−.18**	−.05	−.16*	—
6. COVID stress	3.8 (1.0)	.44**	.46**	.22**	.29**	−.06	—
7. COVID duration (Days)	241.9 (89.0)	−.02	−.04	−.24**	−.10	−.01	−.13	—
8. Relationship length (Years)	2.2 (2.4)	−.05	−.10	−.15*	−.04	−.00	−.21**	−.00	—
9. Age	23.5 (3.6)	−.15*	−.21**	−.08	−.14*	.02	−.33**	−.16*	.47**	—

*p < .05, **p < .001.

Promotive and protective effects of relationship quality on mental health

To test hypotheses 1 and 2, we regressed each outcome variable onto COVID stress, relationship quality, and an interaction term (created by multiplying relationship quality and COVID stress). All variables were centered first to avoid issues of multicollinearity. We used PROCESS version 4.0 for SPSS, which provides regression coefficients for each predictor variable, tests interaction effects, and offers simple slopes between independent and dependent variables at different levels of the moderator (Hayes, 2013). Age, cohabitation, relationship duration, pandemic duration, race and ethnicity, sexuality, and gender were included as control variables. Sensitivity analyses indicated that results did not change with the exclusion of control variables. The analytic sample for each analysis varied slightly (ns = 224–226) due to missing data on individual variables. Effects sizes are estimated using F² and interpreted using Cohen’s (1988) cutoffs (i.e., .02, .15, and .35 indicating small, medium, and large effect sizes, respectively). See Table 3 for results of these regression models and associated effect sizes.

Table 3.

Results of Regression Analyses predicting each Mental Health Outcome.

Predictor	Depression		Anxiety		Alcohol use		Marijuana use
Predictor	B (SE)	Effect Size	B (SE)	Effect Size	B (SE)	Effect Size	B (SE)	Effect Size
Covid stress	3.61 (.59)***	.15	3.54 (.61)***	.13	.07 (.03)	.03	.13 (.04)***	.06
Relationship quality (RQ)	−2.45 (.72)***	.04	−2.02 (.75)**	.02	−.03 (.04)	.003	−.09 (.05)*	.02
Covid stress x RQ	−1.81 (.70)**	.02	−.47 (.73)	<.001	−.02 (.04)	.001	−.02 (.04)	.001
Age	.03 (.17)	<.001	−.07 (.18)	<.001	−.00 (.01)	<.001	−.01 (.01)	.001
Gender minority	1.75 (1.05)	.01	2.89 (1.10)**	.02	−.10 (.05)	.02	.02 (.07)	<.001
Bisexual/Pansexual	−1.48 (1.29)	.005	−.54 (1.34)	.001	−.03 (.06)	.001	.03 (.08)	<.001
Other sexuality	.40 (1.36)	<.001	1.72 (1.42)	.01	−.07 (.07)	.004	−.07 (.09)	.02
Hispanic	−2.72 (1.38)	.01	−.99 (1.44)	.001	−.09 (.07)	.01	−.01 (.09)	<.001
Black	−3.30 (1.49)	.02	−3.61 (1.56)*	.02	−.24 (.07)***	.05	−.00 (.09)	<.001
Other race/Ethnicity	−1.92 (1.63)	<.001	−1.86 (1.71)	.003	−.15 (.08)*	.01	−.04 (.10)	<.001
Pandemic duration	.01 (.01)	.001	.01 (.01)	<.001	−.00 (.00)	.01	.00 (.00)	.004
Relationship length	.20 (.24)	<.001	.16 (.25)	.001	−.02 (.01)	.01	.01 (.02)	.003
Cohabitation	−.81 (.79)	<.001	−.25 (.87)	<.001	.03 (.04)	.002	.01 (.05)	<.001
Overall model
R²	.31		.32		.17		.13
F (df)	6.81 (13, 198)		7.33 (13, 199)		3.20(13, 199)		2.32 (13, 198)

Note. The reference groups for race/ethnicity, sexuality, and gender are White, gay/lesbian, and cisgender women, respectively. Effect sizes were calculated using F².

*p < .05; **p ≤ .01; ***p ≤ .001.

In the model predicting depressive symptoms, as hypothesized, there was a negative association between relationship quality and depressive symptoms with a small effect size, and a positive association between COVID stress and depressive symptoms with a medium effect size. Also as predicted, the interaction term was significant with a small effect size, indicating that relationship quality moderates the association between COVID stress and depressive symptoms. As shown in Figure 1, simple slopes analysis indicated that although there was a positive association between COVID stress and depression at all levels of relationship quality, the association was stronger at low levels of relationship quality (1 SD below the mean), B = 4.87 (SE = .78), t(198) = 6.22, p < .001, than at high levels (1 SD above the mean), B = 2.39 (SE = .74), t(198) = 3.25, p = .001.

Figure 1.

Moderating effects of relationship quality on the association between COVID stress and depressive symptoms.

In the model predicting anxiety, there was a negative association between relationship quality and anxious symptoms, and a positive association between COVID stress and anxious symptoms, both with small effect sizes. Contrary to hypotheses, the interaction term between relationship quality and COVID stress was not statistically significant. Similarly, cannabis use was negatively associated with relationship quality, and positively associated with COVID stress, both with small effect sizes, but was not associated with the interaction between relationship quality and COVID stress. Unexpectedly, alcohol use was not associated with relationship quality.

Discussion

We explored promotive and protective effects of romantic relationship quality on the mental health of SGM-AFAB, a particularly vulnerable population, during the COVID-19 pandemic. We found that COVID stress was associated with negative mental health outcomes in this sample of SGM-AFAB individuals, as has been well-documented in the general population (Haliwa et al., 2021; Panchal et al., 2020) and in a handful of SGM samples (Akré et al., 2021; Flentje et al., 2020; Kamal et al., 2021; Peterson et al., 2021; Salerno et al., 2020). These findings underscore the importance of identifying factors that can promote and protect the psychological functioning of SGM during this public health crisis.

Study findings suggest that high quality romantic relationships are one such factor. Consistent with hypotheses, relationship quality was negatively associated with depressive and anxious symptoms and problematic cannabis use. These findings are congruent with a large literature supporting promotive effects of relationship quality on mental health (Whisman & Baucom, 2012) and cannabis use (Gudonis-Miller et al., 2012) in the general population. In addition, the findings add to growing research demonstrating promotive effects of relationship quality on a variety of mental health outcomes within SGM-AFAB (e.g., Gilmour et al., 2019; Sarno et al., 2021), a group particularly vulnerable to anxious and depressive symptoms (Newcomb et al., 2020) and problematic cannabis use (Watson et al., 2020).

Unexpectedly, the promotive effects of relationship quality did not extend to problematic alcohol use in this sample. This contradicts research showing that poor relationship quality is associated with more problematic drinking cross-sectionally (e.g., Barr et al., 2013; Fleming et al., 2010) and prospectively (Leonard & Homish, 2008; Whisman et al., 2006) within the general population and among SGM-AFAB young people (Sarno et al., 2021). This null finding may have been due to limited variability and positive skew in the AUDIT scores in this sample; perhaps the large minority of nondrinkers, including many under the age of 21, limited our ability to detect associations with relationship quality. In addition, all participants in this sample were currently involved in a romantic relationship, which is associated with less problematic drinking in SGM-AFAB (Whitton et al., 2020, 2021), potentially further limiting variability and power to detect effects. Alternately, it is possible that high relationship quality does not reduce drinking during times of high stress, in the way that it reduces use of other substances (Leonard & Homish, 2008). Although people in relationships drink less than single people, when they do drink, they often do so with their partner (Fleming et al., 2010); drinking during the pandemic may be a unifying activity between partners and thus not associated with poor relationship quality. However, given general population studies indicating that low relationship quality was associated with increased alcohol use during the pandemic (Mitchell et al., 2022), further research is needed to understand the lack of association in this sample.

Relationship quality also demonstrated protective effects against depressive symptoms in the face of COVID stress. For SGM-AFAB that reported higher relationship quality, the association between COVID stress and depressive symptoms was weaker than for those who reported lower relationship quality. This finding extends previous evidence that relationship quality buffers against the harmful psychological effects of general and minority stress (Jackson, 1992; Sarno et al., 2021), by demonstrating its buffering effects against stress associated with the COVID-19 pandemic. Yet, relationship quality did not show stress-buffering effects on the three other mental health outcomes (anxiety symptoms, problematic alcohol and cannabis use) in our sample. Together with parallel findings from a longitudinal study of SGM-AFAB, which found that relationship quality attenuated the within-person associations of sexual minority stress with depressive symptoms, but not with anxious symptoms or problematic substance use (Sarno et al., 2021), these findings suggest that relationship quality’s stress-buffering effects may be specific to depressive symptoms. Perhaps key elements of high-quality relationships (e.g., shared positive experiences and emotional support) protect individuals against some of the unique symptoms of depression (e.g., hopelessness; lack of interest; social isolation), but are less effective at reducing anxiety and substance use, in times of stress.

While we did not hypothesize about racial/ethnic differences in COVID stress and mental health outcomes, the presence of these differences is noteworthy. Black participants reported lower scores on COVID stress, depression, anxiety, and alcohol use than White and Latine participants, which is consistent with general population findings that people of color (POC) report fewer mental health problems and less COVID stress than White individuals (Breslau et al., 2006; McKnight-Eily et al., 2021; NIMH, 2020). These findings contradict some data suggesting that these racial differences may be reversed among SGM (Marshal et al., 2013) and theories that having multiple marginalized identities puts SGM POC at greater risk for experiencing negative outcomes than White SGM (Meyer, 2010). Rather, findings are consistent with the resilience hypothesis, which suggests that SMG POC individuals’ mental health may be protected by mechanisms they developed to cope with racism early in life and apply to later instances of heterosexism (Bowleg et al., 2003; Moradi et al., 2010). Additional research is needed to further explore the associations between marginalized identities and mental health outcomes.

Conclusions should be drawn keeping study limitations in mind. Our project captured a valuable snapshot of SGM-AFAB’s experiences during the pandemic; however, it was not without limitations. For example, although the investigator-created measure of COVID-stress had excellent internal consistency, we were not able to measure its validity prior to use. Furthermore, the measure included items that may overlap conceptually with the measures of depression and anxiety (e.g., “How much has your emotional/psychological well-being been negatively affected by the COVID-19 pandemic?”) and relationship quality (e.g., “How much have your interactions with other people been reduced by the COVID-19 pandemic?”), potentially inflating observed associations. Additionally, data were cross-sectional, prohibiting conclusions regarding direction of effect. We were interested in dyadic processes; however, because we only collected data from one partner we could not test for partner effects. Finally, participants’ reports of key variables, collected across 14 months, may have varied by duration of the pandemic, introducing heterogeneity, though this concern is mitigated by our use of pandemic duration as a control variable in analyses.

Conclusion

Despite these limitations, the present study provides novel information to support potential mental health benefits of high-quality romantic relationships among SGM-AFAB during the COVID-19 pandemic. Specifically, findings suggest that high relationship quality may both promote SGM mental health during public health crises and have stress-buffering effects, reducing the extent to which COVID-related stress is associated with depressive symptoms among SGM-AFAB. As such, findings add to a growing literature asserting the importance of romantic relationships for SGM mental health and the potential of relationship-focused interventions to reduce mental health disparities in this population (Pepping et al., 2020; Whitton et al., 2017).

Footnotes

Author Notes

In 2022, some of this data was presented at the Association for Behavioral Cognitive Therapies Conference and the International Association for Relationship Research Conference.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Collection and analysis of this data was supported by a grant from the National Institute of Child Health and Human Development (Grant R01HD086170; PI: Sarah W. Whitton).

Open research statement

As part of IARR’s encouragement of open research practices, the author(s) have provided the following information: This research was not pre-registered. The data and materials used in the research are available and can be obtained by emailing: sarah.whitton@uc.edu.

ORCID iDs

Sabrina J. Bothwell

Sarah W. Whitton

References

Adamson

S. J.

Kay-Lambkin

F. J.

Baker

A. L.

Lewin

T. J.

Thornton

Kelly

B. J.

Sellman

J. D.

(2010). An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug and Alcohol Dependence, 110(1), 137–143. https://doi.org/10.1016/j.drugalcdep.2010.02.017

Akré

E.-R.

Anderson

Stojanovski

Chung

K. W.

VanKim

N. A.

Chae

D. H.

(2021). Depression, anxiety, and alcohol use among LGBTQ+ people during the COVID-19 pandemic. American Journal of Public Health, 111(9), 1610–1619. https://doi.org/10.2105/ajph.2021.306394

Arnett

J. J.

(2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469

American Psychiatric Association . (n.d.). DSM-5-TR online assessment measures. https://www.psychiatry.org:443/psychiatrists/practice/dsm/educational-resources/assessment-measures

Babor

T. F.

Higgins-Biddle

J. C.

Saunders

J. B.

Monteiro

M. G.

(2001). The alcohol use disorders identification test: Guidelines for use in primary care. World Health Organization.

Barr

A. B.

Culatta

Simons

R. L.

(2013). Romantic relationships and health among African American young adults. Journal of Health and Social Behavior, 54(3), 369–385. https://doi.org/10.1177/0022146513486652

Bartel

S. J.

Sherry

S. B.

Stewart

S. H.

(2020). Self-isolation: A significant contributor to cannabis use during the COVID-19 pandemic. Substance Abuse, 41(4), 409–412. https://doi.org/10.1080/08897077.2020.1823550

Bartlett

M. S.

(1947). The use of transformations. Biometrics, 3(1), 39. https://doi.org/10.2307/3001536

Bowleg

Huang

Brooks

K. D.

Black

Burkholder

(2003). Triple jeopardy and beyond: Multiple minority stress and resilience among black lesbians. Journal of Lesbian Studies, 7(4), 87–108. https://doi.org/10.1300/J155v07n04_06

10.

Braithwaite

Holt-Lunstad

(2017). Romantic relationships and mental health. Current Opinion in Psychology, 13, 120–125. https://doi.org/10.1016/j.copsyc.2016.04.001

11.

Breslau

Aguilar-Gaxiola

Kendler

K. S.

Williams

Kessler

R. C.

(2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36(1), 57–68. https://doi.org/10.1017/S0033291705006161

12.

Buspavanich

Lech

Lermer

Fischer

Berger

Vilsmaier

Kaltofen

Keckstein

Mahner

Behr

Thaler

C. J.

Batz

(2021). Well-being during COVID-19 pandemic: A comparison of individuals with minoritized sexual and gender identities and cis-heterosexual individuals. PLoS One, 16(6), Article e0252356. https://doi.org/10.1371/journal.pone.0252356

13.

Chua

B. S.

Siau

C. S.

Fitriana

Low

W.-Y.

Abdul Wahab Khan

R. K.

(2021). Psychological distress, relationship quality, and well-being among Malaysian couples during the COVID-19 pandemic. Asia-Pacific Journal of Public Health, 33(5), 660–661. https://doi.org/10.1177/10105395211014322

14.

Cohen

(1988). Statistical power analysis for the behavioral sciences. Routledge Academic.

15.

Cohen

Wills

T. A.

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310

16.

Coulter

R. W.

Kenst

K. S.

Bowen

D. J.

Scout . (2014). Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 104(2), Article e105–e112. https://doi.org/10.2105/AJPH.2013.301501

17.

Czeisler

M. É.

Lane

R. I.

Petrosky

Wiley

J. F.

Christensen

Njai

Weaver

M. D.

Robbins

Facer-Childs

E. R.

Barger

L. K.

Czeisler

C. A.

Howard

M. E.

Rajaratnam

S. M. W.

(2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1

18.

Fleming

C. B.

White

H. R.

Catalano

R. F.

(2010). Romantic relationships and substance use in early adulthood. Journal of Health and Social Behavior, 51(2), 153–167. https://doi.org/10.1177/0022146510368930

19.

Flentje

Obedin-Maliver

Lubensky

M. E.

Dastur

Neilands

Lunn

M. R.

(2020). Depression and anxiety changes among sexual and gender minority people coinciding with onset of COVID-19 pandemic. Journal of General Internal Medicine, 35(9), 2788–2790. https://doi.org/10.1007/s11606-020-05970-4

20.

Gato

Barrientos

Tasker

Miscioscia

Cerqueira-Santos

Malmquist

Seabra

Leal

Houghton

Poli

(2021). Psychosocial effects of the COVID-19 pandemic and mental health among LGBTQ+ young adults: A cross-cultural comparison across six nations. Journal of Homosexuality, 68(4), 612–630. https://www-tandfonline-com-s.web.bisu.edu.cn/doi/full/10.1080/00918369.2020.1868186

21.

Gilmour

A. L.

Whisman

M. A.

Randall

A. K.

(2019). Relationship discord and depressive symptoms in sexual minority individuals over time. Journal of Family Psychology, 33(8), 994–999. https://doi.org/10.1037/fam0000554

22.

Graham

J. M.

Barnow

Z. B.

(2013). Stress and social support in gay, lesbian, and heterosexual couples: Direct effects and buffering models. Journal of Family Psychology, 27(4), 569–578. https://doi.org/10.1037/a0033420

23.

Gresham

A. M.

Peters

B. J.

Karantzas

Cameron

L. D.

Simpson

J. A.

(2021). Examining associations between COVID-19 stressors, intimate partner violence, health, and health behaviors. Journal of Social and Personal Relationships, 38(8), 2291–2307.

24.

Gudonis-Miller

L. C.

Lewis

Tong

Aalsma

M. C.

(2012). Adolescent romantic couples influence on substance use in young adulthood. Journal of Adolescence, 35(3), 638–647. https://doi.org/10.1016/j.adolescence.2011.08.011

25.

Hafi

Uvais

N. A.

(2020). Difficulties faced by sexual and gender minorities during COVID-19 crisis. Psychiatry and Clinical Neurosciences, 74(8), 444. https://doi.org/10.1111/pcn.13080

26.

Haliwa

Wilson

Lee

Shook

N. J.

(2021). Predictors of change in mental health during the COVID-19 pandemic. Journal of Affective Disorders, 291, 331–337. https://doi.org/10.1016/j.jad.2021.05.045

27.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis (1st ed.). The Guilford Press.

28.

Hoffart

Johnson

S. U.

Ebrahimi

O. V.

(2021). The network of stress-related states and depression and anxiety symptoms during the COVID-19 lockdown. Journal of Affective Disorders, 294, 671–678. https://doi.org/10.1016/j.jad.2021.07.019

29.

Jackson

P. B.

(1992). Specifying the buffering hypothesis: Support, strain, and depression. Social Psychology Quarterly, 55(4), 363. https://doi.org/10.2307/2786953

30.

Jarrett

B. A.

Peitzmeier

S. M.

Restar

Adamson

Howell

Baral

Beckham

S. W.

(2021). Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people. PLoS One, 16(7), Article e0254215. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270151/pdf/pone.0254215.pdf

31.

Kamal

J. J.

Hahm

H. C.

Liu

C. H.

(2021). Psychiatric impacts of the COVID-19 global pandemic on U.S. sexual and gender minority young adults. Psychiatry Research, 299, 113855. https://doi.org/10.1016/j.psychres.2021.113855

32.

Kidd

J. D.

Jackman

K. B.

Barucco

Dworkin

J. D.

Dolezal

Navalta

T. V.

Belloir

Bockting

W. O.

(2021). Understanding the impact of the COVID-19 pandemic on the mental health of transgender and gender nonbinary individuals engaged in a longitudinal cohort study. Journal of Homosexuality, 68(4), 592–611. https://doi.org/10.1080/00918369.2020.1868185

33.

Leach

L. S.

Butterworth

Olesen

S. C.

Mackinnon

(2013). Relationship quality and levels of depression and anxiety in a large population-based survey. Social Psychiatry and Psychiatric Epidemiology, 48(3), 417–425. https://doi.org/10.1007/s00127-012-0559-9

34.

Leonard

K. E.

Homish

G. G.

(2008). Predictors of heavy drinking and drinking problems over the first 4 years of marriage. Psychology of Addictive Behaviors, 22(1), 25–35. https://doi.org/10.1037/0893-164x.22.1.25

35.

MacCarthy

Izenberg

Barreras

J. L.

Brooks

R. A.

Gonzalez

Linnemayr

(2020). Rapid mixed-methods assessment of COVID-19 impact on Latinx sexual minority men and Latinx transgender women. PLoS One, 15(12), Article e0244421. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774921/pdf/pone.0244421.pdf

36.

Marshal

M. P.

Dermody

S. S.

Cheong

Burton

C. M.

Friedman

M. S.

Aranda

Hughes

T. L.

(2013). Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth. Journal of Youth and Adolescence, 42(8), 1243–1256. https://doi.org/10.1007/s10964-013-9970-0

37.

McGowan

V. J.

Lowther

H. J.

Meads

(2021). Life under COVID-19 for LGBT+ people in the UK: Systematic review of UK research on the impact of COVID-19 on sexual and gender minority populations. BMJ Open, 11(7), Article e050092. https://doi.org/10.1136/bmjopen-2021-050092

38.

McKnight-Eily

L. R.

Okoro

C. A.

Strine

T. W.

Verlenden

Hollis

N. D.

Njai

Mitchell

E. W.

Board

Puddy

Thomas

(2021). Racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance use among adults during the COVID-19 pandemic — United States, April and May 2020. MMWR. Morbidity and Mortality Weekly Report, 70(5), 162–166. https://doi.org/10.15585/mmwr.mm7005a3

39.

Medley

Lipari

R. N.

Bose

Cribb

D. S.

Kroutil

L. A.

McHenry

(2016). Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review.

40.

Meyer

I. H.

(2010). Identity, stress, and resilience in lesbians, gay men, and bisexuals of color. The Counseling Psychologist, 38(3), 442–454. https://doi.org/10.1177/0011000009351601

41.

Mitchell

K. R.

Shimonovich

Bosó Pérez

Dema

Clifton

Riddell

Copas

A. J.

Tanton

Macdowall

Bonell

Sonnenberg

Mercer

C. H.

Field

(2022). Initial impacts of COVID-19 on sex life and relationship quality in steady relationships in Britain: Findings from a large, quasi-representative survey (Natsal-COVID). The Journal of Sex Research, 60(1), 1–12. https://doi.org/10.1080/00224499.2022.2035663

42.

Moradi

Wiseman

M. C.

DeBlaere

Goodman

M. B.

Sarkees

Brewster

M. E.

Huang

Y. P.

(2010). LGB of color and white individuals’ perceptions of heterosexist stigma, internalized homophobia, and outness: Comparisons of levels and links. The Counseling Psychologist, 38(3), 397–424. https://doi.org/10.1177/0011000009335263

43.

Newcomb

M. E.

Hill

Buehler

Ryan

D. T.

Whitton

S. W.

Mustanski

(2020). High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Archives of Sexual Behavior, 49(2), 645–659. https://doi.org/10.1007/s10508-019-01533-9

44.

NIMH . (2020). Major depression. NIMH. https://www.nimh.nih.gov/health/statistics/major-depression.shtml

45.

Panchal

Kamal

Orgera

Cox

Garfield

Hamel

Chidambaram

(2020). The implications of COVID-19 for mental health and substance use (p. 21). Kaiser Family Foundation.

46.

Parrott

D. J.

Halmos

M. B.

Stappenbeck

C. A.

Moino

(2021). Intimate partner aggression during the COVID-19 pandemic: Associations with stress and heavy drinking. Psychology of Violence, 12(2), 95–103. https://doi.org/10.1037/vio0000395

47.

Pepping

C. A.

Halford

W. K.

Cronin

T. J.

Lyons

(2020). Couple relationship education for same-sex couples: A preliminary evaluation of rainbow CoupleCARE. Journal of Couple & Relationship Therapy, 19(3), 230–249. https://doi.org/10.1080/15332691.2020.1746458

48.

Peterson

Z. D.

Vaughan

E. L.

Carver

D. N.

(2021). Sexual identity and psychological reactions to COVID-19. Traumatology, 27(1), 6–13. https://doi.org/10.1037/trm0000283

49.

Philpot

S. P.

Holt

Murphy

Haire

Prestage

Maher

Bavinton

B. R.

Hammoud

M. A.

Jin

Bourne

(2021). Qualitative findings on the impact of COVID-19 restrictions on Australian gay and bisexual men: Community belonging and mental well-being. Qualitative Health Research, 31(13), 2414–2425. https://doi.org/10.1177/10497323211039204

50.

Pieh

O’ Rourke

Budimir

Probst

(2020). Relationship quality and mental health during COVID-19 lockdown. PLoS One, 15(9), Article e0238906. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485771/pdf/pone.0238906.pdf

51.

Pilkonis

P. A.

Choi

S. W.

Reise

S. P.

Stover

A. M.

Riley

W. T.

Cella

(2011). Item banks for measuring emotional distress from the patient-reported outcomes measurement information System (PROMIS): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667

52.

Pollard

M. S.

Tucker

J. S.

Green

H. D.

(2020). Changes in adult alcohol use and consequences during the COVID-19 Pandemic in the US. JAMA Network Open, 3(9), Article e2022942. https://doi.org/10.1001/jamanetworkopen.2020.22942

53.

Randall

A. K.

Leon

Basili

Martos

Boiger

Baldi

Hocker

Kline

Masturzi

Aryeetey

Bar-Kalifa

Boon

S. D.

Botella

Burke

Carnelley

K. B.

Carr

Dash

Fitriana

Gaines

S. O.

Chiarolanza

(2022). Coping with global uncertainty: Perceptions of COVID-19 psychological distress, relationship quality, and dyadic coping for romantic partners across 27 countries. Journal of Social and Personal Relationships, 39(1), 3–33. https://doi.org/10.1177/02654075211034236

54.

Sachser

Olaru

Pfeiffer

Brähler

Clemens

Rassenhofer

Witt

Fegert

J. M.

(2021). The immediate impact of lockdown measures on mental health and couples’ relationships during the COVID-19 pandemic—results of a representative population survey in Germany. Social Science & Medicine, 278, 113954. https://doi.org/10.1016/j.socscimed.2021.113954

55.

Salerno

J. P.

Williams

N. D.

Gattamorta

K. A.

(2020). LGBTQ populations: Psychologically vulnerable communities in the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S239–S242. https://doi.org/10.1037/tra0000837

56.

Sarno

E. L.

Dyar

Newcomb

M. E.

Whitton

S. W.

(2021). Relationship quality and mental health among sexual and gender minorities. Journal of Family Psychology, 36(5), 770–779. https://doi.org/10.1037/fam0000944

57.

Semlyen

King

Varney

Hagger-Johnson

(2016). Sexual orientation and symptoms of common mental disorder or low wellbeing: Combined meta-analysis of 12 UK population health surveys. BMC Psychiatry, 16, 67. https://doi.org/10.1186/s12888-016-0767-z

58.

Slemon

Richardson

Goodyear

Salway

Gadermann

Oliffe

J. L.

Knight

Dhari

Jenkins

E. K.

(2022). Widening mental health and substance use inequities among sexual and gender minority populations: Findings from a repeated cross-sectional monitoring survey during the COVID-19 pandemic in Canada. Psychiatry Research, 307(12155), 114327. https://doi.org/10.1016/j.psychres.2021.114327

59.

Suen

Y. T.

Chan

R. C.

Wong

E. M. Y.

(2020). Effects of general and sexual minority-specific COVID-19-related stressors on the mental health of lesbian, gay, and bisexual people in Hong Kong. Psychiatry Research, 292, 113365. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397990/pdf/main.pdf

60.

Taylor

(2021). COVID stress syndrome: Clinical and nosological considerations. Current Psychiatry Reports, 23(4), 19. https://doi.org/10.1007/s11920-021-01226-y

61.

Vaughn

M. J.

Matyastik Baier

M. E.

(1999). Reliability and validity of the relationship assessment scale. American Journal of Family Therapy, 27(2), 137–147. https://doi.org/10.1080/019261899262023

62.

Watson

R. J.

Fish

J. N.

McKay

Allen

S. H.

Eaton

Puhl

R. M.

(2020). Substance use among a national sample of sexual and gender minority adolescents: Intersections of sex assigned at birth and gender identity. LGBT Health, 7(1), 37–46. https://www.liebertpub.com/doi/pdf/10.1089/lgbt.2019.0066?download=true

63.

Whisman

M. A.

Baucom

D. H.

(2012). Intimate relationships and psychopathology. Clinical Child and Family Psychology Review, 15(1), 4–13. https://doi.org/10.1007/s10567-011-0107-2

64.

Whisman

M. A.

Uebelacker

L. A.

Bruce

M. L.

(2006). Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample. Journal of Family Psychology, 20(1), 164–167. https://doi.org/10.1037/0893-3200.20.1.164

65.

Whittington

Hadfield

Calderon

(2020). The lives and livelihoods of many in the LGBTQ community are at risk amidst COVID-19 crisis. Human Rights Campaign Foundation

66.

Whitton

S. W.

Bothwell

S. J.

Crosby

S. T.

Newcomb

M. E.

(2023). Sexual and gender minority individuals’ perspectives on how the COVID-19 pandemic has affected their couple relationships. In Couple and family psychology: Research and practice. American Psychological Association

67.

Whitton

S. W.

Dyar

Godfrey

L. M.

Newcomb

M. E.

(2021). Within-person associations between romantic involvement and mental health among sexual and gender minorities assigned female-at-birth. Journal of Family Psychology, 35(5), 606–617. https://doi.org/10.1037/fam0000835

68.

Whitton

S. W.

Dyar

Mustanski

Newcomb

M. E.

(2019). Intimate partner violence experiences of sexual and gender minority adolescents and young adults assigned female at birth. Psychology of Women Quarterly, 43(2), 232–249. https://doi.org/10.1177/0361684319838972

69.

Whitton

S. W.

Dyar

Newcomb

M. E.

Mustanski

(2018). Romantic involvement: A protective factor for psychological health in racially-diverse young sexual minorities. Journal of Abnormal Psychology, 127(3), 265–275. https://doi.org/10.1037/abn0000332

70.

Whitton

S. W.

Godfrey

L. M.

Crosby

Newcomb

M. E.

(2020). Romantic involvement and mental health in sexual and gender minority emerging adults assigned female at birth. Journal of Social and Personal Relationships, 37(4), 1340–1361. https://doi.org/10.1177/0265407519898000

71.

Whitton

S. W.

Kuryluk

A. D.

(2014). Associations between relationship quality and depressive symptoms in same-sex couples. Journal of Family Psychology, 28(4), 571–576. https://doi.org/10.1037/fam0000011

72.

Whitton

S. W.

Scott

S. B.

Dyar

Weitbrecht

E. M.

Hutsell

D. W.

Kuryluk

A. D.

(2017). Piloting relationship education for female same-sex couples: Results of a small randomized waitlist-control trial. Journal of Family Psychology, 31(7), 878–888. https://doi.org/10.1037/fam0000337

73.

Xiong

Lipsitz

Nasri

Lui

L. M. W.

Gill

Phan

Chen-Li

Iacobucci

Majeed

McIntyre

R. S.

(2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of Affective Disorders, 277(1), 55–64. https://doi.org/10.1016/j.jad.2020.08.001